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02 June 2015, Volume 31 Issue 6 Previous Issue    Next Issue

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The basic principles and controversies of surgical treatment in cervical cancer. LU Huai-wu，LIN Zhong-qiu. 2015, 31(6): 493-496.  DOI: 10.7504/fk2015050104 Abstract ( )   Abstract:Surgery is the main treatment for early stage cervical cancer.The diagnosis and treatment rely mainly on the basis of two guidelines，that is FIGO and NCCN guidelines.FIGO guidelines updated every three years，while NCCN guidelines updated several times within a year，however，there is little change in the basic principles of surgical treatment.At the same time，the new guidelines also introduced something currently controversial，which including locating low risk factor to avoid parmetrectomy，sentinel lymph node mapping，application of minimally invasive surgical approache etc.In this article，we introduced the basic principles of surgical treatment in cervical cancer as well as discussed the controversial issue.

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Concerns about pelvic and para-aortic lymphadenectomy in the surgical treatment of cervical cancer. DONG Wei-hong，WANG Ze-hua. 2015, 31(6): 496-499.  DOI: 10.7504/fk2015050105 Abstract ( )   Abstract:Pelvic and para-aortic lymphadenectomy are the important parts of surgical treatment of cervical cancer.But there are still some concerns about the lymph node dissection like： how to judge the extent of pelvic lymphadenectomy? When to choose the para-aortic lymphadenectomy and what’s the sentinel lymph node’s effect in the treatment of cervical cancer? We will discuss the questions in the following paper.

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Radical trachelectomy in early cervical cancer: surgical approach and fertility preservation. LIU Kai-jiang. 2015, 31(6): 499-503.  DOI: 10.7504/fk2015050106 Abstract ( )   With the earlier detection of invasive cervical cancer，fertility preservation is increasingly needed.Radical trachelectomy (RT) can be performed vaginally or abdominally (laparotomic，laparoscopic or robotic).The aim of this article was to compare all described techniques performed in patients with cervical cancer eligible for fertility-sparing surgery，in terms of surgical approach employed，surgical outcomes，subsequent fertility rate and obstetrical outcomes.

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Study of retained ovarian in young women with early-stage cervical carcinoma. WANG Min，TAO Tao，WANG Xin-yan. 2015, 31(6): 503-507.  DOI: 10.7504/fk2015050107 Abstract ( )   For the young women with early stage cervical squamous carcinoma who have willingness of reservations ovarian preservation，if there is no family history of breast cancer and ovarian cancer，less than 40 years of age，lesions <4cm，without ovarian metastasis，lymph node metastasis and vascular tumor thrombus in surgical pathological findings，the retained ovarian is necessary，safe and feasible。But if it need to transpose ovarian，before surgery should be fully informed of the risks and complications of ovarian transposition.

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Several problems about pelvic nerve preservation during cervical cancer surgery. CHEN chun-lin. 2015, 31(6): 507-511.  DOI: 10.7504/fk2015050108 Abstract ( )   System Nerve-sparing Radical Hysterectomy that surgical procedures from the proposed implementation to the actual operation has been more than 70 years of development.But with the popularity of SNSRH,the scholars necessity of this surgical implementation，feasibility，indications，surgical standards and assessment methods，such as the efficacy of postoperative also raised many questions.In this paper，according to the above questions，I summarize the results of our research team conducted a preliminary answer，and made comments on the System Nerve-Sparing Radical Hysterectomy surgery improved the problems.

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Surgical treatment for the recurrent cervical cancer. HAN Xiao-tian,WU Xiao-hua. 2015, 31(6): 511-515.  DOI: 10.7504/fk2015050109 Abstract ( )   Despite many disputes for the treatment of recurrent cervical cancer，surgery is still one of the crucial methods to extend the life of patients and have the possibility to treat the recurrence radically.This review will classify the recurrence cervical cancer on the basis of radiotherapy history and recurrence location.Furthermore we will describe different types of surgery and their application for various types of recurrence cervical cancer，and will focus on the latest progress of pelvic exenteration.

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The application and skills of vaginal extension with peritoneum in the laparoscopic radical hysterectomy. WANG Xi-peng，WU Yue-qian. 2015, 31(6): 516-519.  DOI: 10.7504/fk2015050110 Abstract ( )   Abstract:The classic radical hysterectomy for cervical cancer comports resection of 3cm of vagina, thus it has negative consequences on sexual function duo to the shortened vagina. In recent years, vaginal extension with peritoneum in the laparoscopic radical hysterectomy had been applied in many hospitals. Many researches show the procedure is simple and feasible. It can elongate postoperative vagina and does not aggregate operative complications. This procedure helps to improve sexual satisfaction and sexual function in cervical cancer patients.

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Protection strategy of ureter and bladder in radical hysterectomy for cervical cancer. PENG Cun-xu，WANG Yun-fei. 2015, 31(6): 519-521.  DOI: 10.7504/fk2015050111 Abstract ( )   Abstract:The ureter and bladder are adjacent to the female internal reproductive organs. The most common cause of ureter and bladder injury is iatrogenic injury，which is common in gynecological surgery，especially radical hysterectomy. This kind of surgery is so difficult and high-risk that the impossible of urinary tract injuries are increased. It has a serious impact on the quality of life of patients. Therefore，it is important to master the causes and characteristics of urinary tract injuries in cervical cancer surgery，have a good pre-operative evaluation，be familiar with surgical anatomy of the region，properly use of a variety of electrical equipments，master skilled operative techniques，keep intraoperative vigilance in case of a urinary tract injury. But once it happens，the early treatment is so important that it can avoid significant sequelae. It can improve the prognosis and reduce the occurrence of medical disputes.

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Study of the three-dimensional reconstruction model of the nerve and vascular in uterosacral ligament from tissue serial sections. CHEN Chun-lin*，WANG Jun*，LIU Ping*，WANG Li-ling*，DUAN Hui*，LI Wei-li*，ZHANG Yan，WANG Li，HUANG Zhi-xia*，TANG Lei，LI Jian-yi，ZHONG Shi-zhen 2015, 31(6): 530-534.  DOI: 10.7504/fk2015050112 Abstract ( )   Abstract： Objective To study the three-dimensional reconstruction model of nerve vascular tissue for uterosacral ligament.Methods A fresh uterosacral ligament specimen was obtained from a stage ⅠB1 cervical cancer patient who underwent abdominal radical hysterectomy.The direction of the uterosacral ligament was fixed with India ink.The processed uterosacral ligament was then cut coronally at a 5 um thickness，every 5 serial layers as a group.Each slice was stained with HE，TH，VIP，D2-40 and artery fibers.All serial sections were given image acquisition，integration，and its registration.Input images into Mimics software，select the appropriate threshold after positioning and interpolation processing，and then reconstruct the three-dimensional digital model of nerve vascular tissue in uterosacral ligament.Results We successfully reconstructed three-dimensional digital model of the nerve and vessel in the uterosacral ligament.

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Study of the correlation between human’s cumulus cell GREM1 expression and the embryos developmental competence. LIN Su-xia*，HUANG Rong-fu，WU Duan-zong*，WANG Yu-mei*，CHEN Xiao-li*，WU Pei-ya*，LI Jin-gu*，YAO Jian-feng*. 2015, 31(6): 535-538.  DOI: 10.7504/fk2015050113 Abstract ( )   Abstract： Objective To study the close relationship between transcript level of GREM1 in human cumulus cells and the oocyte maturation and the embryo quality，to further probe whether transcript level of gremlin1 (GREM1) in cumulus cells can predict the embryos developmental competence in vitro. Methods A retrospective study was performed on cumulus cells isolated from 160 oocytes retrieved from 42 patients. Based on oocyte maturation，D3 embryo quality and the blastocyst forming capacity，mRNA levels in cumulus cells were assessed by real-time RT-PCR. Results Nuclear maturation was associated with increased expression of GREM1（1.9739±0.5114 vs. 1.5105±0.2629，P<0.001），GREM1 transcript level increased in cumulus cells isolated from D3 high-quality embryos and successful blastocyst forming，compared with the failure group（2.2693±0.4193 vs. 1.9263±0.4912，P<0.05和2.3874±0.2999 vs. 1.5943±0.2078，P<0.001）. Conclusions Results indicate that GREM1 levels in cumulus cells can be correlated with oocyte maturation and the embryo quality，and can be used as possible markers of embryo developmental competence.

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Clinical analysis of 128 cases of pernicious placenta previa. CHEN Jing，NA Quan，ZHUANG Yan-yan，CUI Hong，LIU Cai-xia. 2015, 31(6): 539-542.  DOI: 10.7504/fk2015050114 Abstract ( )   Abstract： Objective To investigate the clinical characteristics of pernicious placenta previa during pregnancy，and to improve the understanding of pernicious placenta previa and accumulate clinical management experience.Methods A retrospective analysis was done in 128 cases of pernicious placenta previa (observation group)and 384 cases of normal placenta previa (control group) in Shengjing Hospital affiliated to China Medical University from August 2009 to August 2014.Results In the observation group,the incidence of placental adherence（22.6%），placenta accreta（44.5%），hysterectomy（20.3%），and transfusion of postpartum hemorrhage（42.2%） were apparently higher those that of control group，the difference being statistically significant (P<0.05).Comparison of two groups on neonatal outcome showed statistical significance (P<0.05) in premature infants.Conclusion Pernicious placenta previa seriously threatens maternal and fetal life.Strictly grasping the indications for cesarean section and reducing the rate of cesarean section is the key to reducing the number of pernicious placenta previa.

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Effects of adjuvant therapy on ovarian function of patients with cervical squamous carcinoma after ovarian suspension. DING Di-nan, WANG Min，TAO Tao，WANG Xin-yan. 2015, 31(6): 543-547.  DOI: 10.7504/fk2015050115 Abstract ( )   Abstract： Objective To investigate the ovarian function of the patients receiving postoperative radiotherapy or chemotherapy after ovarian suspension in cervical squamous carcinoma.Methods Collect 308 cases of cervical squamous cell carcinoma in stage ⅠA~ⅡA patients who underwent radical hysterectomy and pelvic lymph node dissection and ovarian suspension surgery. Divide them into different groups according to the age, the quantity of ovarian suspension (unilateral and bilateral) or whether receiving postoperative adjuvant therapy (chemotherapy，adjuvant radiotherapy, chemotherapy+adjuvant radiotherapy) or not. The modified Kupperman Index was used to investigate the ovarian function of the patients in the following six months after the operation. Results According to the difference of the quantity of ovarian suspension or the age, modified Kupperman score had no statistical significance (P>0.05). Comparing the Group operation + radiotherapy with Group operation,Group operation + radiotherapy + chemotherapy with Group operation, Group operation + radiotherapy with Group operation + chemotherapy ,all the modified Kupperman scores had statistically significant (P<0.05). Comparing the Group operation + chemotherapy with Group operation, Group operation + chemotherapy with Group operation + radiotherapy + chemotherapy,Group operation + radiotherapy with Group operation + radiotherapy + chemotherapy,all the modified Kupperman scores showed no significant difference (P>0.05).Conclusions Postoperative radiotherapy or chemotherapy may affect the endocrine function of ovaries in patients receiving ovarian suspension.The ovarian function may have nothing to do with the age or the quantity of the ovaries.

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Therapeutic effects of transvaginal and laparoscopic operative methods in treating patients with cesarean scar pregnancy. FU Jing-wen，WANG Wu-liang，YUAN Bo，WANG Chen-yang，WANG Li-jun. 2015, 31(6): 548-551.  DOI: 10.7504/fk2015050116 Abstract ( )   Abstract： Objective To explore the clinical effects of transvaginal and laparoscopic operative methods in treating patients with cesarean scar pregnancy（CSP）.Methods The clinical data of 63 cases experiencing surgery for exogenous type CSP in our hospital from June 2012 to July 2014 were retrospectively analyzed. Among the 63 cases，35 cases were performed with transvaginal surgery，28 cases with laparoscopic surgery.The operational time and blood volume，the time after operation and cost in hospital，the postoperative complications，the time required for blood β-HCG returning to normal and menstrual recovery were observed in the two groups.Results Surgery was fulfilled in 63 patients.There were no statistical differences in the age，pregnant time，cesarean time，gestational age，the blood β-HCG level before treatment，CSP mass size and the interval from the last cesarean delivery between the two groups (P>0. 05)；The operational time and blood volume in A group were significantly less than group B (P<0.05)；There were no statistical differences in the time after operation in hospital，the time requiring for blood β-HCG returned to normal and menstrual recovery between the two groups(P>0.05)；The average hospital costs in A group were significantly less than group B(P<0.05).

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Expression and clinical significance of cancerous inhibitor of protein phosphatase 2A （CIP2A） in human ovarian cancers tissues. LI Zheng-tao，FANG Yuan-yuan. 2015, 31(6): 552-555.  DOI: 10.7504/fk2015050117 Abstract ( )   Abstract： Objective To investigate expression and clinical significance of CIP2A in ovarian cancer tissues.

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Efficacy of Estradiol Hemihydrate Patches used in 124 postmenopausal women. GONG Li-li *，ZHANG Shao-fen*，YU Qi,CHEN Rong,RUAN Xiang-yan，LIU Hong-wei，HU Li-na. 2015, 31(6): 556-558.  DOI: 10.7504/fk2015050118 Abstract ( )   Abstract： Objective To investigate the clinical efficacy of Estradiol Hemihydrate Patches （Fem7） in menopausal women.Methods This multicenter（4 hospitals） prospective study enrolled a total of 124 cases of postmenopausal women，who received 24 weeks of Fem7. Progestin was added to those who had intact uterus. Changes in the serum levels of E2 and Kupperman Index were assessed on the time of visits （at the 4th week，the 12th week and the 24th week）. Breast tenderness，vaginal bleeding and adverse reactions such as skin allergy were recorded simultaneously.Results （1） Serum levels of E2: Serum levels of E2 significantly increased with the treatment，(61.09±50.33)pmol/L （before treatment），(198.85±307.29)pmol/L（on the 4th week ，P=0.0003），(258.87±220.40)pmol/L（on the 12th week ，P=0.0001），(219.86±190.21)pmol/L（on the 24th week ，P=0.0000）. （2） Kupperman Index : Kupperman Index significantly decreased with the treatment， 23.91±8.11 （before treatment），9.05±7.56（on the 4th week ，P=0.0000），5.73±5.42 （on the 12th week ，P=0.0000），5.76±7.03 （on the 24th week ，P=0.0000）. （3）No serious side effects were observed during the study. Conclusion    Estradiol Hemihydrate Patches （Fem7） are well tolerated，providing rapid and effective relief of menopausal symptoms with or without oral micronized progesterone or dydrogesterone.

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Clinical research of the correlation of different types and time limit of intrauterine device with infection of female genital tract. YIN Li-li,YANG Qing,WANG Yu. 2015, 31(6): 559-562.  DOI: 10.7504/fk2015050119 Abstract ( )   Abstract： Objective To investigate the correlation of different types and time limit of intrauterine device with the incidence of infection of female genital tract.Methods The clinical data of 1350 patients under intrauterine device removal surgery from Jan.2013 to Jun.2014 in Shengjing Hospital of China Medical University was analyzed retrospectively.The correlation of different types and time limit of intrauterine device with the incidence of infection of female genital tract was studied.It was investigated whether the infection of female genital tract was related to age,gravidity or menopause.Results The incidence of infection of female genital tract in patients with intrauterine device which had tail fiber and more than 10 years was 33.9%, and in less than 10 years it was 14.3%;the difference was significant (P＜0.05).The incidence of infection of female genital tract in patients with intrauterine device which had no tail fiber and more than 10 years was 20.7%,and in less than 10 years it was 16.9%;the difference was not significant (P＞0.05).The high incidence of infection of female genital tract in patients with intrauterine device which had tail fiber was not related to age, gravidity and menopause.The incidence of infection of female genital tract in older patients was 29.4%,lower than youngers.The incidence of infection of female genital tract in the patients with less gravidities was 26.5%,lower than those with multiple gravidities.The incidence of infection of female genital tract in the patients in menopause was 30.7%,lower than the patients in non-menopause,but the difference was not significant (P＞0.05).Conclusion The longer time of the patients with intrauterine device which has tail fiber,the higher incidence of infection of female genital tract.

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Analysis of 10 cases of septate uterus with double cervix and longitudinal vaginal septum. DENG Shan, CHEN Rong，SUN Ai-jun，TIAN Qin-jie，YU Qi，ZHU Lan. 2015, 31(6): 563-565.  DOI: 10.7504/fk2015050123 Abstract ( )   Abstract： Objective To summarize and share experiences of diagnosis and treatment of septate uterus with double cervix and longitudinal vaginal septum. Methods Original data was retrieved from electronic medical record database of Peking Union Medical College Hospital, specific malformations were confirmed according to the description of operation records, and patients concerned were followedup by outpatient medical records and telephone interview.Results All 10 patients complained of infertility, and underwent resection of vaginal septum and laparo-hysteroscopic surgery, with only one exception of open operation for uterine orthopedic.Three patients had spontaneous pregnancy and full-term cesarean section delivery, interval between pregnancy and previous surgery being 2~3.5 years.Conclusion Septate uterus with double cervix and longitudinal vaginal septum is a complex mullerian anomaly in patients with infertility. Hysteroscopic resection of uterine septum is the priority recommendation,keeping double cervix intact.